Methodological approaches for developing, reporting, and assessing evidence-based clinical practice guidelines: a systematic survey.

OBJECTIVE: To produce a mapping and feature summary of approaches and tools available for the clinical practice guideline (CPG) community to develop, report, or assess four types of CPGs: (1) Standard original (or de novo) CPGs, (2) Rapid original CPGs, (3) Adapted/adopted CPGs, and (4) Updated CPGs. STUDY DESIGN: The systematic literature search was conducted using Embase and PubMed, covering the period from January 2010 to October 13, 2020. Two websites that collect and recommend approaches/tools to develop, report, or assess CPGs were also searched: Guidelines International Network and Equator Network. We screened the search results to include methodological papers that aimed to develop specific approaches/tools to develop, report, or assess any of the aforementioned four CPG types. RESULTS: Among 10,581 citations, 46 papers reporting 46 approaches/tools were included. Of these 46 approaches/tools, 33 were about CPG development, seven were for CPG reporting, and six for CPG assessment. Among the 33 development approaches/tools, 26 did not state usability or validity information; but nine from 13 reporting or assessment approaches/tools did. CONCLUSIONS: This study provides an overall summary of the currently available approaches/tools, which serves to improve users' understanding to pave the way for informed choice and application.

Clinical Practice Guidelines: Tools to Support High Quality Patient Care.

Clinical practice guidelines (CPGs) are systematically-developed statements aimed to assist decision-making relevant to the clinical encounter, to inform clinical policy, and to strengthen health care systems. The development of a CPG begins with the identification of a problem for which evidence-informed guidance is required. Interdisciplinary panels work to craft - and then execute - a protocol that will serve as a blueprint for the development process. It includes the scope of the project; who is involved and how they will function; the specific systematic review and consensus methods that will be used to ensure quality recommendations and to mitigate bias. CPGs should undergo a formal review of relevant stakeholders and results of this review, actions taken by the panel, and the final recommendations should be documented in the final CPG report. Dissemination activities, including the use of social media platforms, and more purposefully designed implementation activities are required to optimize the adoption of recommendations. Methods to keep recommendations current are required to ensure on-going validity and credibility of the recommendations. Two tools, AGREE II, and the AGREE REX, provide quality criteria related to the whole CPG development process and the CPG recommendations, respectively. The AGREE II is comprised of 23 items within 6 CPG quality domains: scope and purpose, stakeholder involvement, rigor, clarity of presentation, applicability, and editorial independence. The AGREE REX is comprised of 9 items within 3 CPG Recommendation quality domains: clinical applicability, values and preferences, and implementability. CPGs are important tools to an overall quality agenda.

Priority-based initiative for updating existing evidence-based clinical practice guidelines: the results of two iterations.

OBJECTIVES: New evidence continues to emerge and requires attention after the release of a clinical practice guideline (CPG). The objective of this article is to describe the Document Assessment and Review (DAR) strategy designed to ensue that the CPGs remain current and their quality maintained and to present the results of two iteration of its implementation. STUDY DESIGN AND SETTING: The DAR process involves an annual assessment of our CPGs and a review of documents that require an update search. Two questionnaires are used to conduct the annual assessment and the review. The review involves evidence search, evidence review, and review approval. RESULTS: In 2011, 109 documents were assessed; 22 (20%) were archived, 1 (1%) was deferred for assessment in 2012, 24 (22%) were considered special cases and 62 (57%) needed a new systematic review of the evidence. Of those 62, 19 (31%) were categorized as urgent, 16 (26%) as high, and others as medium or low priority. In 2012, 88 total documents were assessed; 15 (17%) were archived, 32 (36%) deferred, 3 (3%) were considered special cases, and 38 (43%) were prioritized for review. CONCLUSIONS: Assessment and prioritization of existing CPGs are effective ways of ensuring that resources are directed toward the upkeep of those that are relevant and of highest priority.

Guideline for optimization of surgical and pathological quality performance for radical prostatectomy in prostate cancer management: evidentiary base.

BACKGROUND: The objective is to provide surgical and pathological guidelines for radical prostatectomy (RP) with or without concurrent pelvic lymph node dissection (PLND) to achieve optimal benefit for patients, with minimal risk of harm. METHODS: For surgical questions, a literature search of MEDLINE, EMBASE and the Cochrane database was performed. A literature search for the pathological questions was not conducted since the protocol for invasive carcinomas of the prostate gland developed by the College of American Pathologists (CAP) was endorsed. Urologists and pathologists were consulted for their assessment of the surgical and pathological recommendations. RESULTS: Limited high-quality evidence from 95 primary studies was available and, therefore, the expert panel developed recommendations on the basis of a consensus of the expert opinion of the working group and through a consultation with urologists and pathologists. In addition to the CAP protocol, some technical recommendations related to the handling and processing of the specimen were made. CONCLUSION: Radical prostatectomy is recommended for the surgical treatment of prostate cancer, depending on a patient's preoperative risk profile. The panel unanimously determined that the goals for RP are to attain a positive margin rate of <25% for pT2 disease, a mortality rate of <1%, rates of rectal injury of <1% and blood transfusion rates of <10% in non-anemic patients. Standard PLND should be mandatory in high-risk patients, should be recommended for intermediate-risk patients and should be optional for low-risk patients. The quality and effectiveness of this treatment and of subsequent patient care depend on good management, effective communication and reporting between surgeons and pathologists working together as part of a multidisciplinary team. The complete guideline document is posted on the Cancer Care Ontario website (www.cancercare.on.ca); search in their Toolbox, Quality Guidelines & Standards, Clinical Program category under "surgery."

The management of thymoma: a systematic review and practice guideline.

INTRODUCTION: Thymoma is a rare tumor for which there is little randomized evidence to guide treatment. Because of the lack of high-quality evidence, a formal consensus-based approach was used to develop recommendations on treatment. METHODS: A systematic refview of the literature was performed. Recommendations were formed from available evidence and developed through a two-round modified Delphi consensus approach. RESULTS: The treatment recommendations are summarized as follows: Stage I--complete resection of the entire thymus without neoadjuvant or adjuvant therapy. Stage II--complete resection of the entire thymus with consideration of adjuvant radiation for high-risk tumors. Stage IIIA--surgery either initially or after neoadjuvant therapy, or surgery followed by adjuvant therapy. Stage IIIB--treatment may include a combination of chemotherapy, radiation, and/or surgery, or if technically possible, surgery in combination with chemoradiotherapy (concurrent cisplatin based). For bulky tumors, consideration should be given to sequential chemotherapy followed by radiation. Stage IVA--as per stage III, with surgery only if metastases can be resected. Stage IVB--treatment on an individual case basis (no generic recommendations). Recurrent disease--consider surgery, radiation, and/or chemoradiation. Chemoradiation should be considered in all medically inoperable and technically inoperable patients. CONCLUSION: Consensus was achieved on these recommendations, which serve to provide practical guidance to the physician treating this rare disease.